Wilmar Wiersinga1, Miloš Žarković2, Luigi Bartalena3, Simone Donati4, Petros Perros5, Onyebuchi Okosieme6, Daniel Morris7, Nicole Fichter8, Jurg Lareida8, Georg von Arx8, Chantal Daumerie9, Maria-Christina Burlacu9, George Kahaly10, Susanne Pitz11, Biljana Beleslin12, Jasmina Ćirić12, Goksun Ayvaz13, Onur Konuk14, Füsun Balos Törüner13, Mario Salvi15, Danila Covelli15, Nicola Curro16, Laszlo Hegedüs17, Thomas Brix17. 1. Department of Endocrinology and MetabolismAcademic Medical Center, University of Amsterdam, Amsterdam, Netherlands. 2. Department of EndocrinologySchool of Medicine, University of Belgrade, Belgrade, Serbia milos.zarkovic@med.bg.ac.rs. 3. Endocrine UnitOspedale di Circolo. 4. Department of Medical and Surgical SciencesSchool of Medicine, University of Insubria, Varese, Italy. 5. Department of EndocrinologyRoyal Victoria Infirmary, Newcastle upon Tyne, UK. 6. Department of EndocrinologyInstitute of Molecular and Experimental Medicine, Cardiff University School of Medicine, Cardiff, UK. 7. Cardiff Eye UnitUniversity Hospital of Wales, Cardiff, UK. 8. Department of OphthalmologyInterdisciplinary Centre for Graves' Orbitopathy, Olten, Switzerland. 9. Department of EndocrinologyUniversité Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium. 10. Department of Medicine IJohannes Gutenberg University Medical Center, Mainz, Germany. 11. Orbital CenterOphthalmic Clinic, Buergerhospital, Frankfurt, Germany. 12. Department of EndocrinologySchool of Medicine, University of Belgrade, Belgrade, Serbia. 13. Departments of Endocrinology and MetabolismFaculty of Medicine, Gazi University, Ankara, Turkey. 14. OphthalmologyFaculty of Medicine, Gazi University, Ankara, Turkey. 15. Graves' Orbitopathy UnitDepartment of Clinical Science and Community Health, Fondazione Ca'Granda IRCCS, University of Milan, Milan, Italy. 16. Department of OphthalmologyFondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy. 17. Department of Endocrinology and MetabolismOdense University Hospital, University of Southern Denmark, Odense, Denmark.
Abstract
OBJECTIVE: To construct a predictive score for the development or progression of Graves' orbitopathy (GO) in Graves' hyperthyroidism (GH). DESIGN: Prospective observational study in patients with newly diagnosed GH, treated with antithyroid drugs (ATD) for 18 months at ten participating centers from EUGOGO in 8 European countries. METHODS: 348 patients were included with untreated GH but without obvious GO. Mixed effects logistic regression was used to determine the best predictors. A predictive score (called PREDIGO) was constructed. RESULTS: GO occurred in 15% (mild in 13% and moderate to severe in 2%), predominantly at 6-12 months after start of ATD. Independent baseline determinants for the development of GO were clinical activity score (assigned 5 points if score > 0), TSH-binding inhibitory immunoglobulins (2 points if TBII 2-10 U/L, 5 points if TBII > 10 U/L), duration of hyperthyroid symptoms (1 point if 1-4 months, 3 points if >4 months) and smoking (2 points if current smoker). Based on the odds ratio of each of these four determinants, a quantitative predictive score (called PREDIGO) was constructed ranging from 0 to 15 with higher scores denoting higher risk; positive and negative predictive values were 0.28 (95% CI 0.20-0.37) and 0.91 (95% CI 0.87-0.94) respectively. CONCLUSIONS: In patients without GO at diagnosis, 15% will develop GO (13% mild, 2% moderate to severe) during subsequent treatment with ATD for 18 months. A predictive score called PREDIGO composed of four baseline determinants was better in predicting those patients who will not develop obvious GO than who will.
OBJECTIVE: To construct a predictive score for the development or progression of Graves' orbitopathy (GO) in Graves' hyperthyroidism (GH). DESIGN: Prospective observational study in patients with newly diagnosed GH, treated with antithyroid drugs (ATD) for 18 months at ten participating centers from EUGOGO in 8 European countries. METHODS: 348 patients were included with untreated GH but without obvious GO. Mixed effects logistic regression was used to determine the best predictors. A predictive score (called PREDIGO) was constructed. RESULTS: GO occurred in 15% (mild in 13% and moderate to severe in 2%), predominantly at 6-12 months after start of ATD. Independent baseline determinants for the development of GO were clinical activity score (assigned 5 points if score > 0), TSH-binding inhibitory immunoglobulins (2 points if TBII 2-10 U/L, 5 points if TBII > 10 U/L), duration of hyperthyroid symptoms (1 point if 1-4 months, 3 points if >4 months) and smoking (2 points if current smoker). Based on the odds ratio of each of these four determinants, a quantitative predictive score (called PREDIGO) was constructed ranging from 0 to 15 with higher scores denoting higher risk; positive and negative predictive values were 0.28 (95% CI 0.20-0.37) and 0.91 (95% CI 0.87-0.94) respectively. CONCLUSIONS: In patients without GO at diagnosis, 15% will develop GO (13% mild, 2% moderate to severe) during subsequent treatment with ATD for 18 months. A predictive score called PREDIGO composed of four baseline determinants was better in predicting those patients who will not develop obvious GO than who will.
Authors: M Žarković; W Wiersinga; P Perros; L Bartalena; S Donati; O Okosieme; D Morris; N Fichter; J Lareida; C Daumerie; M-C Burlacu; G J Kahaly; S Pitz; B Beleslin; J Ćirić; G Ayvaz; O Konuk; F B Törüner; M Salvi; D Covelli; N Curro; L Hegedüs; T Brix Journal: J Endocrinol Invest Date: 2020-06-10 Impact factor: 4.256
Authors: Peter N Taylor; Lei Zhang; George J Kahaly; Marian Ludgate; Richard W J Lee; Ilaria Muller; Daniel G Ezra; Colin M Dayan Journal: Nat Rev Endocrinol Date: 2019-12-30 Impact factor: 43.330
Authors: Anke Schlüter; Ulrich Flögel; Salvador Diaz-Cano; Gina-Eva Görtz; Kerstin Stähr; Michael Oeverhaus; Svenja Plöhn; Stefan Mattheis; Lars C Moeller; Stephan Lang; Nikolaos E Bechrakis; J Paul Banga; Anja Eckstein; Utta Berchner-Pfannschmidt Journal: Sci Rep Date: 2018-08-30 Impact factor: 4.379